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Biomedical subjects

Daniel J Nagle

Publications and source records attributed to Daniel J Nagle.

7 recordsLinked to original sources
PubMed2006

Complications of endoscopic and open carpal tunnel release.

PURPOSE: To compile the major complications of carpal tunnel surgery and compare reported complications for open and endoscopic techniques. METHODS: A literature assessment was performed for published complications of open and endoscopic carpal tunnel release procedures; 80 publications, representing a period from 1966 through 2001, were reviewed. Complications were identified as neurapraxia; nerve, tendon, or artery injury; and wound infection or dehiscence that required antibiotics or additional operative care. Differences in the proportions of complications between carpal tunnel release procedures were explored with the use of Fisher exact tests. RESULTS: The literature review yielded 22,327 cases of endoscopic carpal tunnel release and 5,669 cases of open carpal tunnel release. For structural damage to nerves, arteries, or tendons, the incidence for open carpal tunnel release is 0.49% and for endoscopic methods (transbursal and extra-bursal), 0.19%. This difference is statistically significant (P < .005; 2-tailed Fisher exact test) and suggests that the overall proportion of structural complications for open carpal tunnel release according to our complication selection criteria is greater than the overall proportion of complications for endoscopic carpal tunnel release. CONCLUSIONS: The proportion of complications for carpal tunnel release, performed through an endoscopic or open approach, is very low. Selection of an open versus an endoscopic approach on the basis of structural complications for nerve, arteries, or tendons is not supported by statistical analysis of published complications. LEVEL OF EVIDENCE: Level III, retrospective comparative therapeutic study.

Carpal Tunnel Syndrome↗
PubMed2004

A comparison of combined arthroscopic triangular fibrocartilage complex debridement and arthroscopic wafer distal ulna resection versus arthroscopic triangular fibrocartilage complex debridement and ulnar shortening osteotomy for ulnocarpal abutment syndrome.

PURPOSE: Treatment of ulnocarpal abutment (UAS) syndrome involves decompression of the pressure and impingement, or abutment of the ulnocarpal articulation. Debridement of triangular fibrocartilage complex (TFCC) tears alone in the patient with UAS may have a failure rate of as much as 25% to 30%. Ulnar shortening osteotomy (USO) can be an effective treatment of failed TFCC debridement. Good results have been reported with combined arthroscopic TFCC debridement and mechanical arthroscopic distal ulnar resection. Similar results have been reported with both ulnar shortening osteotomy and open wafer distal ulnar resections in the UAS patient. Because all of these treatment choices appear to yield similar relief of symptoms, determination of the optimal treatment protocol remains a point of debate. The purpose of this study was to evaluate 2 different surgical treatments for UAS. TYPE OF STUDY: Retrospective review. METHODS: Eleven combined arthroscopic TFCC debridement and arthroscopic distal ulna resections (arthroscopic wafer procedures; AWP) were compared with 16 arthroscopic TFCC debridement and USOs. All patients had diagnostic wrist arthroscopy and arthroscopic TFCC debridement. All patients presented with ulnar wrist pain or neutral or positive ulnar variance, and all experienced at least 3 months of failed conservative management. RESULTS: At mean follow-up times of 21 and 15 months, respectively, 9 of 11 patients showed good to excellent results after arthroscopic TFCC debridement and AWP compared with 11 of 16 after arthroscopic TFCC debridement and USO. A statistically significant difference (P <.05) in the complication rates was identified, including secondary procedures and tendonitis. One secondary procedure and 2 cases of tendonitis were seen in the arthroscopic wafer group. CONCLUSIONS: Combined arthroscopic TFCC debridement and arthroscopic wafer procedure provides similar pain relief and restoration of function with fewer secondary procedures and tendonitis when compared with arthroscopic TFCC debridement and USO, for the treatment of UAS. LEVEL OF EVIDENCE: Level III.

Adult↗
PubMed2003

The Chicago School of Hand Surgery.

The Chicago School of Hand Surgery played a pivotal role in the genesis of the specialty of hand surgery in the United States and abroad. Drs. Alan Kanavel, Sumner Koch, Michael Mason, and Harvey Allen were among the first "modern" surgeons to carefully and systematically assess the care and treatment of hand injuries and hand pathology. This article highlights the lives and contributions of the founders of the Chicago School of Hand Surgery.

Chicago↗
PubMed2002

Endoscopic carpal tunnel release.

Endoscopic carpal tunnel release is not a procedure to be taken lightly. Like many surgical procedures, it is a demanding exercise that requires exacting knowledge of the anatomy of the hand, attention to detail, and the ability to manipulate three-dimensional objects while observing them in two dimensions on a video screen. In the hands of well trained surgeons, ECTR provides patients with a safe, predictable solution to their carpal tunnel sydrome that will allow them a rapid return to normal activities with minimal postoperative discomfort.

Carpal Tunnel Syndrome↗
PubMed2002

Outcome of first-time endoscopic carpal tunnel release in a teaching environment.

PURPOSE: The purpose of this study was to dissect cadaver hands used in the teaching of the Chow endoscopic carpal tunnel release (ECTR) technique and determine the adequacy of transverse carpal ligament (TCL) release and any complications. TYPE OF STUDY: Cadaveric study. METHODS: ECTR was performed on 573 cadaver hands using either the transbursal Chow technique (n = 147) or the extrabursal Chow technique (n = 426). After dissection, the adequacy of the TCL release and any complications were recorded. RESULTS: With the transbursal technique, 58% of the specimens had a complete TCL release. Complications were noted in 11 specimens (7%). Using the extrabursal technique, 70% of the specimens had a complete TCL release. Complications were noted in 15 specimens (4%). The difference in complication rates between the transbursal and extrabursal techniques was significant (P <.05) as was the incidence of partial release (P <.01). CONCLUSIONS: The extrabursal Chow technique is preferred and practice on cadaver specimens is recommended before clinical application.

Cadaver↗
PubMedDate not supplied

Laser-assisted arthroscopic ulnar shortening.

The purpose of this study is to evaluate arthroscopic ulnar shortening with the holmium:yttrium-aluminum-garnet (Ho:YAG) laser for the treatment of ulnocarpal abutment syndrome (UAS). This is a retrospective review of the experience of a single surgeon using this technique between 1994 and 2000. Unloading the ulnocarpal joint is the recognized treatment of UAS. Ulnar shortening via a diaphyseal osteotomy and plating (USO) has been used with good results; however, nearly 50% of patients will require hardware removal. Researchers have reported similar results between open distal ulnar resection (the wafer procedure) and USO for the treatment of UAS. Researchers have also reported similar results with mechanical arthroscopic distal ulnar resections (arthroscopic wafer distal ulnar resection [AWP]) for UAS. Eleven patients who underwent Ho:YAG laser-assisted arthroscopic distal ulnar resection were retrospectively evaluated. The average follow-up time was 31 months, with a range of 7 to 61 months. Evaluation using Darrow' s criteria revealed 64% excellent (7 of 11), 18% good (2 of 11), 9% fair (1 of 11), and 9% poor (1 of 11) results. The average return to work time was 4.7 months, with a range of 1.5 to 16 months. Complications included 1 repeat surgery for ulnocarpal scar formation, 2 cases of transient tendonitis, and 1 portal site erythema without drainage that was treated with antibiotics. One patient (the one with a poor result) has not returned to work for unrelated reasons. chi- square analysis (P <.05) was unable to identify a statistical difference between the reported results of arthroscopic wafer procedures, USOs, and open wafer procedures. We concluded that Ho:YAG laser-assisted arthroscopic ulna shortening procedures show similar results to those reported for arthroscopic wafer procedures, open wafer procedures, and USOs. Return to work times are similar to those reported by other researchers, as is the return to preoperative occupation rate. There is no need for late removal of hardware, as is sometimes associated with USO. Our experience has been that the Ho:YAG laser removes hyaline cartilage and subchondral bone rapidly and with little debris, and thus facilitates the ulna shortening procedure.

Adult↗